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Dr. Alpana Mohta Ranka, MD, DNB, IFAAD, is a dual-board-certified dermatologist with over 90 research publications in peer-reviewed scientific journals.


Malar Rash vs. Rosacea: Understanding the Differences and Treatment Options

Malar rash and rosacea are often confused due to their facial redness and similar appearance. This article clarifies the differences and suggests dermatologist-recommended management strategies for both conditions.

Malar Rash vs. Rosacea

What is Malar Rash?

Malar rash is a distinctive symptom of lupus erythematosus, presenting as a butterfly-shaped erythema over the cheeks and bridge of the nose. It's often a sign of an underlying autoimmune connective tissue disorder and can be aggravated by factors like sun exposure and stress.

What is Rosacea?

Rosacea is a chronic skin disorder characterized by facial redness, small red bumps, and visible blood vessels, primarily affecting the central face. Triggers include dietary factors, ultraviolet radiation exposure (by the sun, sun lamps, and tanning beds), and emotional stress.

Distinguishing Features of Malar Rash

  • Pattern: Symmetric butterfly-shaped rash on cheeks and nose. Usually, it spares the nasolabial fold.

  • Associated Conditions: Often linked with systemic symptoms of lupus or systemic sclerosis. More than half of the patients with systemic lupus erythematosus (acute cutaneous lupus) develop malar rash.

  • Trigger Factors: Exacerbated by sun exposure.

  • Other Symptoms: Other potential symptoms of lupus include skin rash, ulcers on the mouth or nose, prolonged fever, inflammation of joints resulting in arthritis, inflammation in the lungs, heart, or kidneys, neurological complications, reduced hemoglobin level, and abnormal levels of blood cells.

  • Treatment: Focuses on managing lupus with medications like corticosteroids, other immunosuppressants like azathioprine, mycophenolate mofetil, cyclophosphamide, belimumab, and strict sun protection measures, including consistent usage of broad-spectrum sunscreen with an SPF of 50 or higher.

Distinguishing Features of Rosacea

  • Location: Affects central face, including forehead and chin.

  • Symptoms: Persistent redness, flushing, small red bumps, pustules, dilated pores, phymatous swellings (of nose, chin, or forehead), and sometimes eye irritation.

  • Trigger Factors: Includes spicy food, alcohol, caffeine, sun exposure, temperature extremes, and emotional stress.

  • Treatment: Involves avoiding triggers, gentle skincare, and medications like azelaic acid, oxymetazoline, brimonidine, sulphur, and ivermectin, which offer anti-inflammatory benefits and help in reducing redness of skin. In severe cases, oral Isotretinoin, Propranolol, antibiotics like Doxycycline, Pulsed Dye Laser, surgical excision, or CO2 laser excision of phymatous lesions might be required.

  • Do check out our comprehensive guide on azelaic acid usage in the article on Azelaic Acid for Skin.

Lifestyle Management

Both conditions benefit from high sun protection with atleast SPF 50, usage of physician sunscreens containing zinc oxide or titanium dioxide, and a gentle skincare routine. Hypoallergenic fragrance-free moisturizers are recommended for rosacea, as discussed in the article on Sensitive Skin and Rosacea.


Properly differentiating between malar rash and rosacea is essential for effective treatment. Consult a dermatologist for personalized advice.

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